Geographic gaps in accessing scans among issues in abortion provision

Geographic gaps in accessing scans among issues in abortion provision

Occasional difficulties in accessing ultrasound scans were reported to a research group about abortion services.

There are still "significant" challenges in how abortion services are implemented here, according to both doctors and service users.

Newly-published research found that unclear or slow pathway to secondary care in hospitals, occasional difficulties in accessing ultrasound scans, and an uneven distribution and incomplete geographic coverage of abortion services both in communities and in hospitals were highlighted as issues, alongside the statutory three-day wait after the first consultation and problems faced by some migrants who lack a Personal Public Services (PPS) number.

The research, entitled Abortion policy implementation in Ireland: Lessons from the community model of care, was carried out by an 11-strong team led by Joanna Mishtal of the Department of Anthropology, University of Central Florida. It is based on interviews with 79 people, including former minister for Health, Simon Harris. In all, 30 service users were interviewed, along with 13 HSE officials, 10 representatives of reproductive health and justice organisations and four representatives of medical organisations involved in provision of reproductive care and advocacy, plus 22 primary healthcare providers in communities (mainly GPs).

It outlined the "four significant remaining challenges experienced by both GPs and service users in the way abortion services are being implemented in Ireland", even though "the Irish community model of care via medical abortion provision delivered by GPs has been successfully implemented through collaborations between the government and the medical community, GPs’ leadership, and supports for providers and service users".

Unpleasant encounters

One was how GPs are responsible for referring a patient who has reached 10 weeks gestation to secondary care, "but the pathways to transfer patients are not always clear or reliable." 

One interviewee said referral by their own non-providing GPs to abortion providers was "unreliable, at times caused delays, or involved unpleasant encounters".

Another issue was that not all GPs had a reliable and timely pathway to access ultrasound scans, with only six Ultrasound Services locations offering pregnancy dating scans, meaning some GPs instead used local hospitals. It said some lacked adequate staffing "with doctors complaining that 'when that radiographer is off, there is no access to scans'." 

As for the three-day wait after the first consultation, "both the GPs and service users in this study believed that this is unnecessary and can lead to delays".

Also according to the study: "One of the more common queries from GPs directed to the HSE have been about the ineligibility for state-subsidised abortion care of migrants who lack a Personal Public Services number (PPSN), which entitles Irish residents to social welfare, including public health services. Interviews with service users clearly illuminate this problem. Migrants lacking the PPSN or those waiting for the government to issue one have to pay out-of-pocket for at least part of the treatment."

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